[Jessica] Thank you for joining us today. Just a few housekeeping - - PDF document

[Jessica] Thank you for joining us today. Just a few housekeeping announcements: Attendees microphones should be on mute during the conference. After the presentation we will have a question and answer session. You may submit questions through the conference platform at any time. During the Q&A, we will try to get to every question that wasn’t otherwise covered. Please note, the conference is being recorded and will be available for viewing online. Without further ado, I’ll hand this over to James for Time For Homes!

[James] Thank you for joining Time For Homes today—we’re a new organization; having just formed in late April. Already, we are gaining a great deal of momentum as we work to end homelessness. Thank you for your part in that. We believe that adequate shelter is a human right and with more than half a million homeless people across the nation and a large percentage of those in New York, we have a duty to band together to solve this issue. Time For Homes advocates for a housing-first philosophy to end chronic homelessness in New York State by 2025. Time For Homes does this by working with a four-pronged approach: Offering permanent housing, first. Providing trauma-informed supportive resources, such as health services and job placement, through our community-based agency and nonprofit partners. Partnering with all levels of government to effectuate systemic change in how we address homelessness and poverty.

Working with homeless and formerly homeless individuals to ensure those at the margins have agency and a voice at the table. Time For Homes is focused on solving this crisis in New York State to use it as a model to roll out nationally. 2

• The Time For Homes Approach
• The Power of Data for Good
• Quantifying the Problem
• Homelessness in Present Context
• Homelessness as a Health Condition
• Treatment Plan
• What has been done
• Considerations & Imperatives
• Public Participation
• What we need to do
• Q&A Session

Agenda

[James] Keeping in mind that time is your scarcest commodity, we will try to cover a lot of ground in a relatively short time. We will review Time For Homes’ approach and conduct a high-level overview of our core programs. We will define the problem and examine a few key facets thereof in historical, current, and future contexts. Additionally, we will look at homelessness as a health concern—exploring the issue and how we can resolve it (as individuals, as an organization, and collectively as a society). We’ll end with a question and answer session. As a reminder, you can send in questions at any time during the presentation and we’ll endeavor to cover as many unanswered ones that time allows. If we don’t get to your question during the call, we will get back to you individually. 3

• Time For Homes has a broad, inclusive definition of

homelessness in order to mitigate the risks of inequality, exclusion, and discrimination against those who may need specialized assistance such as people living in situations of vulnerability or in slums or those facing forced eviction.

• Homelessness is living in severely inadequate housing due to a

lack of access to minimal acceptable housing.

We all know what homelessness is, right?

[JAMES] Now, it is all well and good to say we want to eradicate homelessness, right? But to solve a problem you must first have an understanding of what precisely that problem is. According to the United Nations, homelessness can include many conditions ranging from “rough sleepers” (i.e. people sleeping on the street) to people living in inadequate or insufficient housing (i.e. people living in tents) to people in temporary

• r emergency accommodation (such as homeless shelters) to “hidden” homelessness

(like those who are “couch surfing” or living with friends or family. Article 11 of the ratified United Nations International Covenant on Economic Social and Cultural Rights, section 1 states, in part, that the covenant recognizes the right of every person to an adequate standard of living for themselves and their families, including adequate food, clothing, and housing. Alongside the United Nations and myriad other organizations, Time For Homes takes positive measures to improve the living conditions fo homeless people with a view of 4

facilitating their full participation in society and to prevent and eliminate homelessness, as well as to combat and eliminate its criminalization. Time For Homes has a broad, inclusive definition of homelessness in order to mitigate the risks of inequality, exclusion, and discrimination against those who may need specialized assistance such as people living in vulnerability, in slums, or those facing forced eviction. Homelessness is living in severely inadequate housing due to a lack of access to minimal acceptable housing. Homelessness is one of the most acute forms of material deprivation. Homelessness refers to the inability of people to enjoy a permanent accommodation. Homelessness often means lacking other basic human rights, such as the rights to: work; healthcare; social security; privacy, and education. Homelessness is both a cause and a symptom of human rights being denied, abused, and violated. It is one of the most visible and most severe symptoms of the lack of respect for the right to adequate housing. 4

What is adequate housing?

[JAMES] How do we know if housing is adequate? We have to look through a lens that covers all manner of safety—physical, mental, social, economic, et cetera. It’s almost easier to say what it is not. Housing is not adequate if its occupants do not have a degree of tenure security which guarantees legal protection against forced evictions, harassment, and other threats. Housing is not adequate if its occupants do not have safe drinking water, adequate sanitation, energy for cooking, heating, lighting, food storage, and refuse disposal. Housing is not adequate if its cost threatens or compromise the occupants’ enjoyment of other human rights. Housing is not adequate if it does not guarantee physical safety or provide adequate space, as well as protection against the cold, damp, heat, rain, wind, and other 5

threats to health or structural hazards. Housing is not adequate if the specific needs of disadvantaged and marginalized groups are not taken into account. Housing is not adequate if it is cut off from employment opportunities, healthcare services, schools, childcare centers and other social facilities, or if it is located in polluted or dangerous areas. Housing is not adequate if it does not respect and take into account the expression of cultural identity. 5

• Time For Homes partners with an ever-growing number of service

providers—offering a platform for collaboration; a community for networking; and a number of scalable services.

• Time For Homes works with a number of government officials, legislators, and

the like to support and advocate for effective policy.

• Time For Homes actively encourages public participation and education

about the issues of and relating to homelessness.

Our Approach

[James] Alright, so what are we doing about it? Time For Homes resides in a relatively niche space in the landscape of organizations working to end homelessness. We are not a provider of direct services. We are not, strictly speaking, an advocacy group nor are we a lobbying organization. That leaves us to define what we are—and why we feel that this is the space to

• ccupy.

We are somewhere in the middle of all those. Time For Homes partners with an ever growing number of service providers—offering a platform for collaboration (to build, refine, prove, and promulgate best practices); a community for networking; and a number of scalable services (from communications support to data analysis and myriad other areas) to help those organizations achieve 6

their missions. This area is in a constant state of capacity building—so we are always

• pen to a conversation of what else we can do to work together efficiently and

effectively. Time For Homes works with a number of government officials, legislators, and the like to support and advocate for effective policy. Time For Homes actively encourages public participation and education about the issues of and relating to homelessness. It is only with a multifaceted approach, bringing to bear the expertise of an extensive network of partners, that we can hope to achieve systemic, sustainable, surviving societal change. 6

• We are all in this together
• We’re asking all of our partners, fellows, and advisors to present their ideas,

research, and work when it is appropriate for them.

• Together, we can refine, model, test, and prove the necessary aspects for the

solution to the criminal lack of housing security in the United States.

Building Consensus, Driving Change

[James] It is clear that no one entity can ever hope to end homelessness throughout the United States—or even just New York State. It is only with a strong level of collaboration that the imperative of ending homelessness can be even remotely possible. To that end, we are building consensus and driving change with our complementary cadre of partners, fellows, and advisors—formal and informal. We are fortunate enough to already have a robust network of policy experts and academics in a number of related sub-disciplines, partner organizations that are working diligently both on the front lines of the homelessness epidemic and in the fight for systemic change, and advisors from all walks of life bringing their experiences and expertise to bear on this formidable problem. That said, we are bringing on more and more collaborators each week. If you know of someone that may be interested—let them know we’re actively expanding our roster. They can learn more and contact us through our website, 7

Time4Homes.org. We are all in this together; thus we don’t consider this a one-way street. In keeping with our core commitment to stewardship, Time For Homes will be consistently working towards being a value-add partner for all we work with. Going forward, these stakeholders will have a more active role in these calls. We’re asking all of our partners, fellows, and advisors to present their ideas, research, and work when it is appropriate for them. Neither Time For Homes nor myself claim to have all the answers—that’s where this group of dedicated individuals come in. Together, we can refine, model, test, and prove the necessary aspects for the solution to the criminal lack of housing security in the United States. I’ll take a short pause here to have Malachi introduce our Data for Good program. Malachi? 7

• Gather Data: Varied Data sets, and a robust base
• Analyze Data: Data science Conclusions and

Predictions

• Improve Data: Data techniques to use the Data itself to

improve the Data

• Applications
• Models: Predict the problem and Preempt need
• Scientific techniques: Use various techniques

already in use, but adapt them

Data for Good: Introduction & Applications

[Malachi] Our "Data for Good" program aims to use data to help inform policy making and program creation. It is, in essence, applying the concept that the private sector uses to save money, to instead save lives—while remaining fiscally responsible. To break down this far reaching goal into more manageable pieces we have three goals overarching in this program. First, Gathering Data: collecting as many varied data sets as are available to us, in

• rder to create a robust base to draw from for our next goal

Second, Analyzing Data: Using data science to breakdown the gathered data to attempt to draw conclusions and predict various needs. Thirdly, Improving Data: It is well known that the data regarding Homelessness is rather lackluster and often falls short of the desired accuracy. This goal represents our desire to attempt new methods of improving this data, using high level analytical techniques—including modeling and optimization techniques used in fields like 8

medicine and physics. We aim to create Mathematical Models which will be able to predict homelessness to some degree of accuracy. There are already some ideas regarding stochastic modeling, or using a compartmental model in this application. We also hope to improve the data accessible to other individuals and organizations by using techniques available from the scientific community that improve the data available to them through the use of matrix completion methods and other similar techniques. 8

• Not simply PIT and directly related
• Robust and widespread net
• Social services like Medicare/Medicaid,

child welfare

• Partnering, FOIL, and MOU
• Organizations, Government, Programs
• Continuing to gather data consistently

Data for Good: Gather Data

[Malachi] For our "Data for Good" program we want to gather as much data as possible. This does not simply refer to Point In Time counts or data sources directly relating to Homelessness, it also means that we want to gather data regarding things like, food stamp usage, Medicare/Medicaid usage, child welfare, and various other related social aspects to the Homelessness issue. In order to accomplish the robust and widespread gathering of data we will collate data from the usual sources of first—Data sets from HUD, World Bank, and various

• ther commonly used sources with similarly common data sets.

Some of this data we will be available for use without the need to jump through any hoops but for the next level of Data we will need to work with other organizations and with government agencies—some under Freedom of Information Act Law requests and others we’ll be able to do so with Memoranda of Understanding. This data will start to get more robust, entering related realms that are not directly 9

related to Homelessness. We are hopeful that these Memoranda of Understanding we may enter into with some of our partners will give us a trove of useful data and that, in turn, we can provide them with data insights that help them run their programs. 9

• Basic
• Metrics and Figures
• Where is the problem worst?
• Who is most affected?
• Advanced
• Models
• Neural Networks
• Data applications
• Sharing

Data for Good: Use Data

[Malachi] Time For Homes’ "Data for Good" program will used gathered data to do several things. At a basic level we will conduct data analysis to break down the raw data into understandable metrics and accurately answer questions like "where is the problem worst?" Or "who is affected most?" And variations thereof. At a more advanced level we will attempt to create models and other applications to attempt to investigate more thoroughly the homeless issue. Some of these other applications are Neural Networks attempting to predict increases or decreases in Homeless numbers, or a data application that aggregates information on Homelessness into a word cloud to help break the issue into more manageable sub-issues such as substance-dependency, or access to work, or a Model which does the same thing as the Neural Network, but in a more concrete way. These will be used to help inform policy and advocate change and progress. 10

Time For Homes intends to share these applications and insights with our partners, fellows, and advisors—the issue is too big to solve on our own, everyone should have access to these tools and resources. As time goes on and the needs of our organization and those of our partners grow, we will add needed forecasting models and other applications, in order to serve all

• ur stakeholders to the best of our ability.

10

• Current Data
• Existing and there, but flawed
• Most are underestimates with some glaring

holes

• Statistical and Mathematical analysis
• Use data to fix Data
• Matrix completion
• Compressed sensing

Data for Good: Improve Data

[Malachi] One key aspect of our "Data for Good" program is the idea that we can improve quality of the data that is available regarding the homeless issue. Currently it is widely held that the majority of data regarding Homelessness is lackluster and not nearly as accurate as it should be. To be fair, it is workable, and that fact that it exists at all is commendable. However, there are ongoing efforts to create more accurate data on homelessness. The methods most commonly used include but are not limited to gathering data from related sources, and creating new techniques to gather the data. We think, while this is all well and good, perhaps an analysis of the data itself could provide some level of improvement. We aim to use Statistical, Mathematical, and scientific techniques to use existing data 11

to fill in its own holes. An example of one such technique is Matrix completion, and it is often used in the medical field to make tests and scans more accurate without sacrificing the ability to do these tests in the first place. In the medical field this is called Compressed sensing. We hope to use similar or adapted techniques to look at the existing data and tune it to be more accurate through this more technical and advanced techniques. Now that we’ve explored just some of our tools, I’ll hand it back over to James to help us define the problem and go over the next steps. James? 11

• Preventing and eliminating homelessness is a moral

and social imperative

• We have a rare combination of a state government

that has the interest, capacity, and will to make real, lasting change

• We have an engaged public that is very concerned

with housing insecurity

Imperative of Change

[James] Preventing and eliminating homelessness is a moral and social imperative. People experiencing street homelessness in every corner of the globe face negative

• utcomes related to mortality, health, ability to earn a basic income, and other basic

elements of survival. A homeless, or inadequately housed, person is highly at risk of suffering from poverty, hunger, poor health, lack of access to education, clean water, and sanitation. Furthermore, homelessness contributes to rising inequalities and prevents the growth of sustainable and inclusive cities. Though we are adamant that working to end homelessness and promote housing security is the right thing to do, there are some who oppose it. Those people frequently state funding for shelters, permanent housing, and social welfare programs for the homeless often are rife with systemic inefficiencies and fraud. They claim that these funds could be better used to 12

create jobs or provide family and career counseling. Others argue that since an individual is responsible for his or her homelessness, providing such support is immoral because it creates a culture

• f dependency and encourages free-riders. The argument that “homelessness

is a choice” includes the belief that individuals are choosing not to work, and thus to not have income for housing, and the belief that individuals are homeless through “deviant” life choices such as using drugs or alcohol. However, these lines of argument disregard the health and economic factors leading to homelessness. Being homeless is a complex issue covering individual adults and children, as well as two-person and single-parent families. Responding to homeless families raises some complex ethical issues, such as whether it is better to keep children with parents in a homeless shelter or whether or not to return abuse victims to potentially dangerous situations. While these concerns are valid and could be addressed if better evidence were made available, this does not preclude the need to provide support to families and their children in times of need In addition, there is political and philosophical opposition to prioritizing social services for housing and homeless programs (so-called “political will”) within governmental entities and in communities at large that contribute their taxes to such programs and elect representatives to reflect such priorities. Underprioritization of such services tends to disregard the preventative and cost-saving characteristics of social services aimed at addressing homelessness and instead focuses on opportunity cost trade-offs and a cost-minimization approach to governance. This means that such political will fails to recognize the costs of services already being supported to address the adverse effects of homelessness such as health care and criminal justice system costs. That said, due to myriad factors—not the least of which is the ongoing pandemic— we have a unique opportunity in front of us to achieve meaningful, systemic change

• n this front.

We have a rare combination of a state government that has the interest, capacity, and will to make real, lasting change. We have an engaged public that is very concerned with housing insecurity—and the 12

slice of the populous that harbors that concern is rapidly growing. We are experiencing the first positive shifts in how society thinks about social safety nets in decades. In short, both the need and the wherewithal for change are immense and growing. To give us a sense of the numbers and what they mean, I’ll turn you back over to Malachi: 12

• 104 evictions per day in New York State,

2,350,042 total in the United States

• 92,091 number of homeless in New York

State, 567,715 number in the united states

• We were doing well, reducing Homelessness

1.5% since 2014, however we increased by 3.2% since 2016, and 2.7% since 2018 compared to 2019.

By the Numbers

[Malachi] Numbers are a very useful for quantifying the issue in a way that is concrete, comparable, and reproducible. This usually comes after a step of identifying there is a problem, but we already know that, and that New York is particularly bad. There are some variety of numbers available but bear in mind these “current” numbers are from 2019. The 2020 numbers are not yet widely available. Current best counts indicate there are more than 567,000 homeless people around the country. Of those, more than 92,000 are here in New York State. Overall we had been making progress combating this issue – since 2014 we saw a nationwide decrease in the homeless population of 1.5%. However if we look at numbers more recently we have been increasing. Since 2016 there has been a 3.2% increase in overall homeless population, and since 2018 there has been a 2.7%

• increase. To be clear this is nation wide, what happens in individual states is different.

New York has only increased its population. 2019 is literally the highest point in

• verall homeless in New York there has been. And if the pattern continues this will
• nly get worse.

13

Clearly, the problem is mammoth. Let’s dig into how we got those numbers though. 13

• Pros
• Decent estimate
• Easily accessible
• Demographic/geographic
• Most complete
• Cons
• Once a year
• Hidden Homeless
• Untrained

Overall useful, but flawed and inconsistent

By the Numbers: Point in Time Counts

[Malachi] The previous numbers are from the Point in Time Counts. Most of us know what those PIT counts are, but just so everyone is on the same page: PIT counts refer to a conglomeration of data done by HUD, the department of Housing and Urban Development, where they take data that is reported to them regarding a count done on a single day during the last ten days of January. The PIT count is a useful data set that estimates the number of homeless in given areas however it has some failings. For instance it is not accurate when counting people who are not out on the street. Those people who are the so-called “hidden” homeless. Additionally, since it is conducted only once each year, it does not note people who are in and out of homelessness. 14

It basically boils down to, the PIT count is done once a year, by mostly untrained volunteers, and thus it only provides a slice of the possible data, and usually a drastic underestimation. However, despite its flaws, it is one of the best tools in our arsenal because it provides a large amount of data in one place. It contains data about demographics, and breaks down homeless types. It is also broken down geographically. This type of grouped data is very useful because it allows us to conduct more precise and detailed analysis that takes into account these things like geographic areas or demographics. In essence, it is the most complete data available to people who are analyzing Homelessness data. Thanks, James, back to you. 14

• People who are homeless are disproportionately older and sicker,

than society at large. Many have underlying conditions – such as lung disease and diabetes – that set them up for disastrous

• utcomes.
• We have built structures based on inequities, racism, and injustices.

This has disproportionately left poor communities and communities

• f color exposed to acquiring and getting sick from this virus.
• COVID-19 is clearly a public health issue and so is homelessness.

COVID-19: Public Health, & Homelessness

[James] By now we must all be aware of the global corona virus pandemic which has caused severe social and economic disruption worldwide. Like many things, it has a disproportionate effect on homeless people. People who are homeless are disproportionately older and sicker, than society at

• large. Many have underlying conditions – such as lung disease and diabetes – that set

them up for disastrous outcomes. Add a highly communicable disease that spreads through a respiratory mode to a population often living in crowded conditions with poor access to basic hygiene, and you have a nightmare scenario. Even without a pandemic, it’s impossible to stay healthy when you are homeless. The situation today is heartbreaking. People are terrified. They are wondering, “Am I going to catch this? Am I going to die out here?” The COVID-19 pandemic is laying bare some ugly societal problems. 15

One strikingly obvious issue is that many of the people who need to keep working are the very same people who are at risk for homelessness or are experiencing homelessness. These “essential” jobs cannot be done remotely. They cannot afford to get sick and they are some of the lowest paid, least protected members of the labor force. Another glaring issues is the insidious effect that racism has on health. COVID-19 is exacting a devastating toll on Communities of Color. These are the same people who are exceptionally vulnerable to becoming homeless, nearly homeless, or living in severely overcrowded housing. Let’s go over a quick example of how systemic racism effects your health

• utcome.

Say you live in a house you were able to buy in a suburb because two generations ago your family was allowed to live in the suburbs because they are white. You’ve had access to quality education your whole life, and as a result you have a job you can do from the comfort of your dining room table during the pandemic so you can continue to get paid—Or you have money so that you can shelter in place. You’re going to be infinitely more protected from a pandemic than someone working a low-paid, frontline job while living with multiple roommates. Or someone who’s sleeping rough or residing in a homeless shelter. Viruses are neither elitist nor racist, but viruses operate within societal conditions. We have built structures based on inequities, racism, and injustices. This has disproportionately left poor communities and communities of color exposed to acquiring and getting sick from this virus. This increased level of potential positive cases directly translates to more infections and subsequently further adverse health conditions for people. Not to put too fine a point on it, this is killing us. COVID-19 is clearly a public health issue and so is homelessness. 15

• Brookings Institution say that a startling indicator of the economic

impact of COVID-19 is that unemployment rates have reached the highest level since the Great Depression this April.

• The survey found that 24 percent of respondents lost a job or

income due to COVID-19. Most of these job or income losses were due to being furloughed or experiencing reduced work hours.

• Washington Post reported that an “understated estimate” would be

nineteen to twenty-three million renters at risk of eviction by September 30th of this year.

COVID-19: Economic Costs & Homelessness

[JAMES] Our colleagues at the Brookings Institution say that a startling indicator of the economic impact of COVID-19 is that unemployment rates have reached the highest level since the Great Depression this April. As a result, claims for unemployment benefits have risen dramatically, though millions of people who have lost their jobs have been unable to apply or have had trouble applying for this benefit. Yet these figures do not reveal the extent to which households are struggling financially as a result of a COVID-19 related job loss. To report findings about COVID-19 job and income losses and financial hardships, the Social Policy Institute at Washington University in St. Louis administered a unique nationally representative survey to 5,500 respondents from April 27 to May 12 . A job loss is one of the worst financial shocks most families will face, making it extremely difficult to make ends meet and avoid devastating downstream effects like foreclosures or evictions. During the COVID-19 pandemic, unemployment reached historic heights with more than forty million claims of unemployment—even exceeding the unemployment levels during the Great Depression 16

The survey found that 24 percent of respondents lost a job or income due to COVID-19. Most of these job or income losses were due to being furloughed

• r experiencing reduced work hours.

However, these job and income losses were not experienced equally. Hispanic, low-income, and young individuals (between the ages of 18 and 24) had the highest rates of job and income loss compared to other racial/ethnic, income, and age groups. While job and income loss rates were very similar among moderate-, middle-, and high-income respondents, low-income and Hispanic respondents—those least able to cope with economic shocks—had a distinctly higher rate of job and income loss. That job and income losses were highest among Hispanic respondents is likely related to their disproportionate representation in industries hard hit by COVID-19 related layoffs such as hospitality and

• construction. Conversely, black workers are disproportionately represented in

industries such as health care and transportation that have been less affected. One way to see that COVID-19 related job and income losses are affecting the ability of US households to make ends meet are to look at the different types

• f economic hardship. Survey respondents had problems in paying rent and

mortgage payments, problems in paying other bills, put off medical care, put

• ff filling a prescription, and had food insecurity.

These findings illustrate the economic pain of families who have lost jobs or income due to the pandemic—they look beyond the official unemployment and job loss figures. They’re particularly notable given that the survey was conducted early in the pandemic (April, to be precise) and the hardships would have only grown. The hardships have many negative consequences—putting individuals and families at risk for eviction especially when the moratoria of evictions expire and households struggle to pay their rental arrears. The downstream effects of the inevitable evictions are varied and far-reaching: loss of possessions, disruptive school changes, loss of friends, mental health distress, and much more. In May, more than 40% of working age adults were substantially worried about their ability to pay upcoming rent. In the intervening time that has just gotten worse. Just this week the Washington Post reported that an “understated estimate” 16

would be nineteen to twenty-three million renters at risk of eviction by September 30th of this year. Even granted a stay of eviction to pay back rent is unlikely to make a material difference as the overall economic recovery and job market is not on pace to keep up with demand. Others are forecasting that there will be another wave of infections that demand further stay-at-home orders that will further decimate the recovery- lessening the chances people can avoid evictions. 16

• Health Complications From Homelessness
• Exacerbates existing medical conditions
• High levels of stress
• Cleanliness challenges resulting in infections
• Nowhere to safely store prescriptions
• Exposure to the elements
• Heightened risk of injuries
• Benefits of Housing
• Medicaid expenses drop significantly
• Improved health outcomes

Health & Homelessness

[James] We’ve already seen how a pandemic emergency can make homelessness a public health emergency—that said, it’s a public health emergency due to factors outside of COVID-19. The American Public Health Association has classified housing insecurity and homelessness as an issue of public health. Homelessness continues to be a recalcitrant public health problem in the United States, as those experiencing homelessness have high rates of chronic physical and mental health conditions, co-occurring disorders, and barriers to health care (such as the inability to access care when needed or the ability to comply with prescribed medications) and affordable housing. Research on personal and structural barriers in accessing treatment for co-occurring substance use and mental health disorders indicates that individuals experiencing homelessness or those with criminal justice involvement often have fewer treatment resources, lack transportation, and have more limited access to services, particular 17

those in rural areas. These barriers to treatment may lead to increases in chronic conditions and may hinder housing and income stability. Research also indicates that individuals experiment homelessness have a risk of mortality that is up to eleven-and-a-half times greater than the risk in the general

• population. Research supports findings of higher mortality rates and chronic disease

loads among individuals experiencing homelessness than among those who are housed. Along with treatment of chronic health conditions, stable housing is preventing communication diseases, a classic example would be tuberculous though now we are seeing the corona virus as a most urgent issue. Homeless individuals also overuse emergency services, leading to higher treatment

• costs. Studies report that a quarter to a third of homeless individuals are hospitalized

during a given year and that those individuals have significantly rates of emergency department use than the general population. These costs add up, and research estimates that maintaining a person living on the street or in a shelter can cost between thirty-five and one-hundred-fifty thousand dollars annually—just accounting for expenses due to use of the emergency room or contact with law enforcement. As a result, increasing housing stability and ending homelessness are critical factors in reducing health system overload and associated costs. Additional studies have documented that housing-first programs for chronically homeless individuals reduces expensive emergency department

• usage. A study in Oregon revealed a fifty-five percent reduction in Medicaid

claims for individuals one year after they obtained housing, while research in Chicago showed that housing and supportive services led to a twenty-nine percent reduction in hospital days and a twenty-four percent reduction in emergency department visits. Here in New York the Frequent Users Service Enhancement initiative, which provided housing to two-hundred individuals with frequent jail and shelter stays, documented that an incredible ninety-one percent of participants remained stably housed after twelve months, and annual total costs for crisis medical and behavioral health care services were reduced by more than seventy-three-hundred dollars per person. Hawaii is currently exploring some interesting approaches related to this. 17

• Emergency Department Homeless Assessment Pilot Program
• Hawaii Homeless Healthcare Hui (H-4)

Hawaii: Innovating Homeless Treatment

[James] Hawaii created an Emergency Department Homelessness Assessment Pilot Program within the housing-first model. The Legislature found “that there is excessive utilization of hospital emergency department resources by homeless individuals for non-emergency needs. Many of these users are considered super utilizes—meaning they visit the emergency department at least three times per week, are admitted to the hospital at least three times per month, or visit the emergency department at least twelve times per quarter, and suffer from mental health and substance abuse issues.” The Program appropriated funds for use in identifying individuals experiencing homelessness with the goal of providing case management to those who require supportive services and to demonstrate effectiveness in mitigating the increasing cost

• f medical care and unnecessary use of the hospital emergency department and to

establish a medical respite pilot offering medical, nursing, psychiatric, and other care for homeless individuals after being discharged from a hospital. 18

The legislation provided that a participating community human service provider, in partnership with a hospital participating in the pilot program, shall provide emergency housing for eligible individuals experiencing homelessness who are discharged from he hospital and provide, at minimum, meals, case management, and medical, nursing, and psychiatric care. The program has, among others, the goals of: preventing homelessness; reducing the length of time program participants spend homeless; exit individuals or families to permanent housing; and, reduce returns to homelessness. Embedded in the program is a requirement that a variety of supportive services are billed to Medicated, under the 1115 Medicaid demonstration waiver. Providing these services are expected to improve sustainability by decrease costs through decreasing the amount of emergency department and inpatient stays the beneficiaries need. They have found that the provision of these services results in improved integration

• f all services, increased effectiveness of care coordination, increased individual

involvement in their care, improved health outcomes, and reductions in unnecessary

• r inefficient use of emergency department health care.

This Pilot goes along with the Hawaii Homeless Healthcare Hui, or H-4, Vision. H-4 is meant to provide a safe, functional environment for those in need to get services and treatment and to alleviate the financial and medical strain on over taxed emergency departments. It is a public-private partnership which creates a new model to address chronic homelessness. It lowers costs, improves outcomes, and lessens criminal justice involvement. 18

• Many cities are choosing to criminally punish

individuals for carrying out life-sustaining tasks such as sleeping in public, loitering, sitting or lying down in public, sleeping in vehicles, sharing food, and panhandling.

• Many states and municipalities continue to pass laws

that criminalize behaviors associated with homelessness

Criminalization & Homelessness

[James] Let’s talk about that criminal justice involvement. First off, being poor is not a crime. Not having income and housing security —that’s not a crime. But we often treat them as such. If a crime exists in this area, it’s not the individual but rather society as a whole that is negligent. Criminalization measures in effect across the United States that target activities associated with homelessness are not only ineffective in reducing homelessness and costly to enforce but serve as a barrier to income and housing stability. The National Law Center on Homelessness and Poverty conducted a survey of the municipal codes in 187 cities and found that despite a shortage of housing and shelter options, many cities are choosing to criminally punish individuals for carrying out life-sustaining tasks such as sleeping in public, loitering, sitting

• r lying down in public, sleeping in vehicles, sharing food, and panhandling.

19

The survey results showed that 53% of cities prohibit sitting or lying down in public places, 43% prohibit sleeping in vehicles, 76% prohibit begging in particular public places, and 9% prohibit sharing food with people experiencing homelessness. These criminalization measures do nothing to address the underlying causes of homelessness, as most police interventions are temporary and result in a fine that homeless individuals are often not able to pay, exacerbating their financial instability. Criminalization of these measures is costly for taxpayers to enforce, and a study in Colorado showed that six of the state’s cities spent more than $5 million enforcing 14 anti-homelessness ordinances. Criminal records negatively affect an individual’s access to housing, benefits, and employment, and these barriers are not limited to homeless adults. Homeless children and youths are also subject to liability under these

• rdinances, along with ordinances that apply uniquely to them such as status
• ffenses and truancy.

Many states and municipalities continue to pass laws that criminalize behaviors associated with homelessness. While some of these laws have been struck down, many more are taking up costly resources to enforce and are ineffective in reducing homelessness or the criminalized behavior they are intended to deter. As a result, it is critical for communities in the United States to adopt constructive alternatives to criminalizing basic life-sustaining activities that individuals must perform in public spaces if there is no shelter or housing available. The housing-focused solutions Time For Homes advocates for are critical to reducing the behaviors that these laws are designed to deter. Individuals and families who have a safe, permanent place to live will no longer need to sleep in public or be targeted as loitering. However, while pursuing housing is the ultimate goal, decriminalizing the life- sustaining behaviors of people experiencing homelessness and recognizing their fundamental human rights are essential. Money spent on enforcement of these laws could instead be spent on developing affordable housing options, reinvesting in community services for homeless citizens, or establishing street

• utreach teams to increase engagement in services.

19

Homelessness outreach teams staffed by police officers in Houston, Minnesota, and Milwaukee have proved successful in diverting homeless individuals away from jails when they are in a mental health crisis, saving the criminal justice system additional funds. Finally, many cities and states across the country have enacted a homeless bill

• f rights, which is legislation that prohibits the criminalization of homelessness

and discrimination against those experiencing homelessness. These rights include the right to move freely in public places, share food, rest, and ask for donations while being protected from harassment from police or others. 19

Diagnosis Prevention Treatment Modeling

Learning From the Medical Community

[James] Rather than treat homelessness as a criminal justice issue, Time for Homes recommends treating homelessness as we would a disease—albeit with a more systemic approach than the limited scope currently piloting in Hawaii. We need to ensure myriad resources are available—like you might have a range of

• ver-the-counter and prescription medications available to treat a disease—and look

at each person and family experiencing homelessness individually. The path to housing stability for each individual should be regarded in the same way the medical community looks at a treatment plan. As a hospital generally accepts whoever walks through the doors, so to we must provide adequate housing before anything else. It should not be dependent on someone having navigated a treatment system (such as for substance abuse)

• beforehand. It’s unrealistic to expect someone to be able to take care of those needs

if they don’t even know where they can rest that night. 20

Studies show the housing-first model works—especially when combined, when necessary, with varying degrees of supportive housing. We can also avail ourselves of other techniques the medical community uses—from diagnosis, prevention, treatment (obviously), and, interestingly, modeling. Let’s hear from Malachi about that. 20

• Modeling is the creation of equations which can

closely match real world events allowing us to predict future events to a reasonable degree of accuracy.

• There are many different commonly used methods

to model events to reasonable degrees of accuracy—currently well-known is disease modeling.

Modeling: What We Can Do

[Malachi] As I briefly mentioned earlier, there are a number of techniques the scientific and medical communities use to harness data. Hopefully most of us are at somewhat familiar with the concept of modeling, but as a brief introduction let me give a summary of modeling and how it works. Modeling is the mathematical study of physical phenomena in the attempt to quantify change and predict future change. To put it simply, Modeling is the creation of equations which can closely match real world events allowing us to predict future events to a reasonable degree of accuracy. Additionally Modeling is often able to explain and quantify parts of the world we don't currently understand very well, or takes things we do understand and allows us to change some of the context in order to allow us the ability to analyze specific situations. 21

Now that we have a common understanding of Modeling allow me to explain how Time For Homes plans on using it. There are many different commonly used methods to model events to reasonable degrees of accuracy. One of the most commonly used, and currently well known is disease modeling. There are many Disease models but they all fall under what are called Compartmental models. We will adapt this flexible approach to model the Homeless. This can be done in a geographic sense, a demographic sense, or simply with overall population. Though hopefully this can eventually be done all together for additional accuracy and use. This leads to the question of how we know its accurate. Well, to confirm that models are accurate we have two main techniques. First you can simply make sure that the model will accurately represent any equation given to it within the bounds of its

• theory. Secondly we can interpolate, that is, make sure the model well represents the

data we already know. In effect, Modeling will allow us to take the data and “knowns” that exist and predict, accurately, what will happen when we introduce various potential changes. This allows us to see what will happen if we do X or do Y. It can be used not only in the context of a “medical approach” but in other areas such as ensuring we improve equitable access to support. For that, back to James. 21

• We stand with the Black Lives Matter

movement because it is the right thing to do.

• We stand with the Black Lives Matter

movement because it would be irresponsible to do anything else.

• We stand with the Black Lives Matter

movement because to sit idly by while society

• ppresses our sisters and brothers is counter to
• ur very mission.

The Call for Justice

[James] Society is inequitable. We see it on the news and in the streets every day. We know it’s true by our own experiences and the experiences of others. People of Color and other minorities are more likely than white people to be

• homeless. They are more likely to be victimized by the institutions sworn to

protect them—the government in general and the criminal justice system and police in particular. Our current moment in history harbors a call for justice. Our mission, and our core values of inclusion and support, mean that we are inherently supportive of this call to justice. However, in a time of such turmoil and animosity toward progressive change, we feel it is necessary to state our support explicitly. We stand with the Black Lives Matter movement because it is the right thing to

• do. We stand with the Black Lives Matter movement because it would be

22

irresponsible to do anything else. We stand with the Black Lives Matter movement because to sit idly by while society oppresses our sisters and brothers is counter to our very mission. Fixing our society is not an easy or comfortable thing; however, it is necessary. We support the call for change—for racial equality, equity, and justice. A just, civil society must always care for the marginalized with the same level

• f concern as it does for the most privileged.

While our particular mission focuses on housing, we cannot and will not tolerate unwarranted attacks on our fellow citizens—especially those in groups that are already under siege by the very systems of government and economics that run our country; the very systems we engage with in achieving

• ur mission.

While many of the issues are outside of our remit, economic and housing justice are solidly under our banner. We work alongside Black Lives Matter and other civil leaders to effectuate this

• change. It is long overdue. It will not be easy. It will not be comfortable. But it

will be just and proper. And the numbers speak for themselves, Malachi? 22

By the Numbers: Equality?

[Malachi] It’s not just our shared, anecdotal experience. The statistics are staggering. As you can see in the upper right chart, African Americans make up just about thirteen-point-three percent of the population, they make up at least thirty-nine percent of the homeless community. Somewhere between thirty and forty-five percent of homeless youths identify as LGBT+, whereas they make up five-to-ten percent of the general population. As you can see here, people of color, LGBTQ people—especially youths—and other minorities make up more than their share of the homeless population. In keeping on with the mention of the Black Lives Matter movement and Criminal Justice Involvement let’s take a look at a few startling facts: African Americans are roughly five-point-one times more likely to be incarcerated than white people—up to ten times more likely in some areas. 23

In urban areas, African Americans are more than twenty-five percent more likely to face pre-trial incarceration. Now, let’s explore why African Americans, in particular, are disproportionately represented. According to the national alliance to end homelessness. African Americans have been systematically denied equal rights and opportunities. The effects of long-standing discrimination linger and perpetuate disparities in poverty, housing, criminal justice, and health care, among other areas. These disparities, in turn, can contribute to more African Americans experiencing homelessness. Poverty, particularly deep poverty, is a strong predictor of homelessness, and African American households are much more likely to experience poverty than their White

• counterparts. More than one in five African Americans live in poverty—more than

two-and-a-half times more than whites. Black families are more likely to live in areas of concentrated poverty — areas that have limited economic opportunities, fewer services, and poorer educational

• resources. People who become homeless are likely to have lived in these

neighborhoods immediately before their homelessness. Data shows that African Americans often face barriers when attempting to move to more favorable neighborhoods. A study by the U.S Department of Housing and Urban Development (HUD) found that people of color were often shown fewer rental units, offered higher rents, and denied more leases than Whites. The incarceration rate for African Americans tripled between 1968 and 2016. A history of involvement with the criminal justice system can keep people from successfully passing background checks needed to secure housing or employment. People exiting jails and prisons face significant problems in accessing safe and affordable housing, which can result in homelessness. People whose serious mental illness goes untreated are particularly vulnerable to homelessness; both poverty and lack of access to care contribute to disparities in mental health. African Americans are 10 percent more likely to report psychological distress than Whites and are far more likely to be uninsured. More than half of U.S. 23

residents without health insurance are people of color. So clearly, it will take some systemic changes to build a truly just and fair society. To that end, let’s see what’s happening now in New York. James? 23

• Rent relief for the pandemic to help prevent

homelessness

• Providing additional resources to help veterans

recover from homelessness

• Easier way for developers to provide

affordable housing.

What New York State Is Adding

[James] New York State leads in some areas while it trails in others regarding the prevention and recovery of homelessness. The State is home to huge numbers of organizations and agencies working on this intractable problem. Unfortunately, it’s just not enough. There are a number of bills under in various states of consideration in the State legislature. From the great—things like rent relief for the pandemic to help prevent homelessness to providing additional resources to help veterans recover from homelessness and making it easier for developers to provide affordable housing. And, unfortunately, a few that aren’t so great—ones that make it harder to build supportive or transitional housing. 24

Though Time For Homes isn’t a huge advocate for shelters—they do serve a purpose, especially until systemic change can be achieved, and even then won’t be totally unnecessary. The Governor has a five year plan (seemingly for most issues) but specifically to increase the availability of supportive housing. This is a good step. It’s just not enough. We need more, and that’s where our platform comes in. 24

• Commit to promote the Housing First model
• Adequately appropriate funds for rental assistance
• Mandate a minimum level of homeless services in all areas
• Focus on health and health outcomes in their policy making
• The government at all levels to de-criminalize homelessness and adopt a homeless bill of rights.
• Creating operating procedures and guidelines for the services it provides
• Those guidelines to be tailored for the individual—that so-called “treatment plan” model we discussed

earlier.

• Adequate access to transportation
• Build into city planning and zoning requirements that adequate affordable housing and resources
• Peg minimum wage to the consumer price index
• Enact a comprehensive tenants bill of rights that protects tenants while still ensuring fairness across

the board

• Require that unoccupied properties that have been seized or repossessed by its agencies be made into

affordable housing

• Move funding from the criminalization of homelessness to the provision of services to combat the

homeless problem—in popular parlance, defund the police.

T4H Draft Platform

[James] Time For Homes is developing a platform that lists our key policy positions. This iteration is a very rough draft. It is meant only to serve as a starting point for discussion. A copy of the full platform will be made available with the resources from the

• conference. It’s open for public comment, but more to the point we are looking for

insight from our Partners, Fellows, and Advisors. We’ll return to this over the upcoming quarterly meetings—those meetings will be more interactive and less of me talking, I’m sure you’ll all be happy with that—in

• rder to hash it out and make sure it address our collective concerns in a fair,

equitable, effective way. For now, we want: The government to commit to promote the Housing First model, prioritizing low- barrier access to housing with an emphasis on harm reduction. 25

The government to adequately appropriate funds for rental assistance, and expand those existing programs so they are sufficient to meet the need. The government to mandate a minimum level of homeless services in all areas, including provision of the basic necessities to make a home habitable—a minimum that is adequate to the need. The government to have a focus on health and health outcomes in their policy making with a commitment to truly adequate housing. The government at all levels to de-criminalize homelessness and adopt a homeless bill of rights. The government to, in creating operating procedures and guidelines for the services it provides, support tailoring of interventions for special populations demonstrated to be at excess risk of homelessness, particularly vulnerable while homeless, or disparate lay accessing or receiving housing or homeless services. Further to allow those guidelines to be tailored for the individual—that so-called “treatment plan” model we discussed earlier. The government to ensure adequate access to transportation, so individuals may receive services and attain opportunities regardless of whether or not they can walk to a particular office—through a combination of subsidizing public transportation and ride share services. The government to build into city planning and zoning requirements that adequate affordable housing and resources for people experiencing homelessness or at-risk for becoming homeless. The government to peg minimum wage to the consumer price index, so that it provides a living wage outside of prevailing political considerations. The government to enact a comprehensive tenants bill of rights that protects tenants while still ensuring fairness across the board. The government to require that unoccupied properties that have been seized or repossessed by its agencies be made into affordable housing. The government to move funding from the criminalization of homelessness to the provision of services to combat the homeless problem—in popular parlance, defund the police. 25

I’m sure there’s more, and I know these aren’t refined. Again, they’re just a starting point—we hope to have your reactions and insight shared with us in the coming weeks. 25

• Offer engaging workshops to our volunteers
• Educate volunteers on the myriad aspects of

homelessness and how recovery works

• Work with volunteers to provide direct outreach

to individuals who are homeless or at-risk of being homeless

T4H Event Series

[James] We can’t do this alone. Ending homelessness is a big task—one that requires a broad base of public support. One of the ways Time For Homes seeks to garner that support is through an upcoming event series—when that will launch will depend on a number of factors (COVID-related social distancing requirements and the capacities of our partners and

• ur sponsors).

That said, we will be holding a series of events in communities around the country with our nonprofit partners, and the support of our generous sponsors, that will combine education and outreach. We will offer engaging workshops to our volunteers that help them become effective advocates for the systemic change we need. We will educate them on the myriad aspects of homelessness and how recovery works. 26

We will work with them to provide direct outreach to individuals who are homeless

• r at-risk of being homeless.

This will look different in different areas, based on the needs of the community and the needs of our partner organizations. Perhaps they will assist with street outreach, provide care packages, work in a soup kitchen, or something else. The point is not the specific engagement action but rather the empathy it will foster—making them a better advocate for the disadvantaged. 26

• Enacting common sense legislation that

recognizes the inherent rights and worth of the individual.

• We need to build a coalition of support for a pilot

project of treating homelessness as a medical condition while taking into account the larger context.

Way Forward

[James] That brings me to the next steps. What is the way forward? From a societal perspective, it is simultaneously simple and exceptionally complex. Everyone needs a basic amount of security—and where society fails even a single individual it has failed all of us. Let’s not mince words, society is failing. It doesn’t have to stay this way. Simply by enacting common sense legislation that recognizes the inherent rights and worth of the individual. Obviously, that’s easier said than done—as a society we’ve been working on this seemingly forever. In the past few decades we’ve spent uncountable billions on this and we haven’t achieved a whole lot. 27

Sure, we’ve made dramatic impacts on many, many lives. Unfortunately, though, the homeless problem remains. More specifically for Time For Homes, we’ll be focusing on a couple of areas. First, we need to expand our network of partners, advisors, and fellows. We need to build a coalition of support for a pilot project of treating homelessness as a medical condition while taking into account the larger context. We are looking to do so on a smaller scale within a condensed region of New York State for, perhaps, two

• years. Enabling us to take the data and lessons and expand that into a statewide

approach. That statewide approach will be a solution in New York, of course, but will also serve as a pilot for the rest of the nation. While this is all ongoing, we need to bring the public into the conversation and improve the efficiencies of service delivery. This is not an easy road, but the journey is possible. Now, what does that mean for each of us. 27

• For the Fellows, Partners, and Advisors among you:

We need your help refining the position platform. We need your help in expanding our network.

• For the members of the media with us:

When you write stories touching on homelessness, consider the issue in the larger context. We are here as a resource to you, and frankly, we’d love it if you write about the approach we’re looking to implement.

• For everyone:

Spread the word—I think we can all agree that there is a problem of homelessness—follow us on social media and share what you find

• interesting. Support our work, make a contribution that is meaningful to

you.

What You Can Do

[James] We all have at least one role in this effort to end homelessness. For the Fellows, Partners, and Advisors among you: We need your help refining the position platform. We need your help in expanding our network. For the members of the media with us: When you write stories touching on homelessness, consider the issue in the larger context. We are here as a resource to you, and frankly, we’d love it if you write about the approach we’re looking to implement. For everyone: spread the word—I think we can all agree that there is a problem of homelessness—follow us on social media and share what you find interesting. Support our work, make a contribution that is meaningful to you. This project has been something Malachi and I have funded out of pocket. We’re awaiting our IRS determination letter and have some funding pledged from a few foundation, but especially now every little bit helps. 28

We’re a lean organization, but things cost money—more than you think they should. I recently asked our fellows/advisors/partners to make a contribution. I’m happy to say we’re on track to have 100% participation, but we are definitely not there yet. Other than that? Do what you’ve been doing. You are all here because this is a cause you believe in. Keep trying to make this world a better place each day. 28

Questions

& Answers

Please send your questions to: Hello@Time4Homes.org

[Jessica] Thank you, Malachi. Thank you, James. We have just a little bit of time—about X minutes for question and answer session. You may keep sending in questions, but here we go: <Q&A> Alright, thank you, everyone. That’s all the time we have for the Q&A. James? 29